Namaka Michael, Leong Christine, Grossberndt Amy, Klowak Meghann, Turcotte Dana, Esfahani Farid, Gomori Andrew, Intrater Howard
Room 319 Apotex Ctr, Faculty of Pharmacy, University of Manitoba, Winnipeg, MB, Canada R3E 0T5.
Consult Pharm. 2009 Dec;24(12):885-902. doi: 10.4140/tcp.n.2009.885.
The purpose of this review is to provide an update of the neuropathic pain treatment algorithm previously published by Namaka et al. in 2004. This algorithm focuses on the strategic incorporation of the latest pain therapies while providing an update of any recent developments involving medications previously listed in the algorithm.
PubMed, MEDLINE, Cochrane, and Toxnet databases were used to conduct all literature searches on neuropathic pain and targeted treatment strategies. Comprehensive search efforts in the identified databases included studies published between 1980 and 2009. The search term "neuropathic pain" was used along with each of the agents outlined in this review: pregabalin, paroxetine CR, duloxetine, tramadol XL, Tramacet, Sativex, and nabilone.
A total of 90 studies were reviewed and selected based on level 1, 2, and 3 search strategies.
Level 1 search strategies were initially aimed at evidence-based trials of large sample size (N > 100), with a randomized, double-blind, placebo-controlled design conducted by investigators well versed in the specialty area of interest. A level 2 search was conducted for additional trials that had many, but not all, of the desirable traits of evidence-based trials. In addition, a level 3 search strategy was conducted to compare key findings stated in anecdotal reports of very small (N < 15), poorly designed trials with the results of well-designed, evidence-based trials identified in level 1 and/or level 2 searches.
Based on a thorough evaluation of the literature, pregabalin, paroxetine CR, and duloxetine have been placed in the updated algorithm as first-line agents, while tramadol XL, Tramacet, Sativex, and nabilone function primarily as adjunctive agents.
The updated algorithm provides a baseline framework from which clinicians can justify the medication they prescribe.
本综述旨在更新纳马卡等人于2004年发表的神经性疼痛治疗算法。该算法重点在于战略性地纳入最新的疼痛治疗方法，同时更新算法中先前列出药物的近期进展。
使用PubMed、MEDLINE、Cochrane和Toxnet数据库对所有关于神经性疼痛和靶向治疗策略的文献进行检索。在已确定的数据库中进行的全面检索工作包括1980年至2009年发表的研究。检索词“神经性疼痛”与本综述中概述的每种药物一起使用：普瑞巴林、控释帕罗西汀、度洛西汀、缓释曲马多、曲马多/对乙酰氨基酚复方制剂、萨替维克斯和纳布啡。
根据1级、2级和3级检索策略共审查并选择了90项研究。
1级检索策略最初针对大样本量（N>100）的循证试验，由精通相关专业领域的研究人员进行随机、双盲、安慰剂对照设计。对具有许多但并非所有循证试验理想特征的其他试验进行2级检索。此外，进行3级检索策略，以比较非常小样本量（N<15）、设计不佳的试验的轶事报告中所述的关键发现与1级和/或2级检索中确定的设计良好的循证试验的结果。
基于对文献的全面评估，普瑞巴林、控释帕罗西汀和度洛西汀已被列入更新后的算法中作为一线药物，而缓释曲马多、曲马多/对乙酰氨基酚复方制剂、萨替维克斯和纳布啡主要起辅助药物的作用。
更新后的算法提供了一个基线框架，临床医生可以据此证明他们所开药物的合理性。
